MCL tear after 5 months

[Gingerflash]

I injured my medial collateral ligament in February. Slipped in the snow, foot went sideways while knee stayed still, putting a valgus bend on the joint. Pain straightaway, prety bad, physio for a few weeks (very limited on the NHS) and it improved a lot.

However, my recovery seems to have plateau'd after about 6 weeks. I can walk and cycle (I ride road and mountain bikes a lot) without trouble. I have a full range of movement.

The joint seems to seize up when still. This happens in any position, sitting lying down, standing up. The pain at night can be enough to wake me. During the day I consciously try to keep the joint moving to prevent pain. If it's still for 20 minutes or more, it'll be painful when I try to move it and will gradually ease off.

There is a small area of extreme tenderness of the medial surface of the head of the tibia. If I lie on my side in bed, one knee touching the other is painful.

The joint feels unstable. Walking on uneven ground sometimes causes strong pain on the medial aspect of the knee. I haven't dared run more than a few strides as the joint feels very wobbly. I also get pain in the joint very quickly, eg running across the road. Any slight sideways load on the knee is very painful around the area of the MCL.

Does all of this sound normal for an MCL injury at 5 months or should I be seeking some further help?

My GP thinks I need to see an orthopaedic surgeon. I have no problem with that but don't want to waste anyone's time if this is all just pretty normal and will get better with time.

I'd be really grateful for any advice. Just looking for a "don't worry, it's all normal" or a "crikey, I'd get that looked at if I were you".

Thanks,
Richard

(I'm 34 years old, 175lb and in good health)

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[crossin]

Hi Richard,

Have you recovered from the injury? I injured my knee over two months ago while skating. Just got the MRI report back saying there's a partial tear on MCL (8 mm,) grade 2 injury. What I have experienced is very similar to what you described, the tender spot, and I still cannot straighten my injured knee. The pain is more obvious when standing up after having sat for a while or getting out of the car. I had done 6 weeks of physiotherapy before the physiotherapist told me to get an MRI.
What did you do to improve your condition or what professional advise did you get?

Thanks,
Jonathan

[markmiller]

Have you tried foam rolling your quads, Glute Medius and IT band? This will probably help take a lot of pressure off the knee and may relieve some of the pain.

[crossin]

Have you tried foam rolling your quads, Glute Medius and IT band? This will probably help take a lot of pressure off the knee and may relieve some of the pain.

Thanks for your suggestions. I will definitely check them out. Is "full recovery" possible? I have a partial tear on MCL now and just hoping that I can ski when winter comes.

Jonathan

[markmiller]

I can't say if a full recovery is possible or not, but I can tell you that doing the right kinds of exercises and stretches can be very helpful.

[Ironmike]

I think that you are going down the right lines with cycling and walking and generally moving the knee about. Typically a grade 2 sprain will take about a month to repair, but seeing as you are now 5 months post injury, I would be a little concerned. Have you followed a strengthening program for the knee extensors, and also the hip muscles? Thinking about the biomechanics of your leg, and the fact that you like to cycle a lot would lead me to suspect that maybe you suffer from a weak glute med coupled with tight adductors that are allowing your leg to bend in at the knee when walking/running/on uneven surfaces. Strengthening the medial glutes would provide greater support for your knee as it does it's job, and prevent excessive valgus stress being put through the joint. Have you been biomechanically assessed? Working at the other end of your limb, a medial foot wedge in your shoes might keep the ankle in a better position. Do you know if you have flat feet? An overpronation at the ankle could potentially lead the knee to fold inwards as you move and again cause valgus pain through the medial aspect. Finally, strengthening of the medial quads may be of help, alongside stretching of the ITB, or indeed foam rolling. Inner range leg extensions (working through the last 20 degrees of knee extension and locking out for 5 seconds at end of ROM) with your foot pointing at the 2 o'clock position may be of help to strengthen VMO and provide more strength.

In short, you should be walking around fine by now I would have said, so yes there may be some cause for concern in my viewpoint. It would however depend on what you had been doing for the last 5 months, as if you haven't been doing the right exercises, or none at all, then it is possible that you will have stiffness and a giving way feeling in the knee anyway.

Let me know if you need any clarification.

[Ironmike]

To explain the above a bit more - it's not because you cycle that I am saying that you are weak, but I am an avid cyclist too and the tendency is for the knees to point inwards towards the top tube, thus shortening the adductors in the hip. This is coupled with then glute med being on a constant stretch, and shortening of the hamstrings which can again lead to an adduction of the leg (semi-membranosus and tendinosus). In short, it is pretty hard to speculate as to what is going on without seeing you moving, but hope all this helps a bit!